ANTERIOR CERVICAL CORPECTOMY FOR CERVICAL SPONDYLOTIC MYELOPATHY

OBJECTIVE: To evaluate the efficacy of anterior surgery for the treatm ent of cervical spondylotic myelopathy, we have reviewed our experienc e with anterior cervical corpectomy (ACC) at the University of Florida , specifically analyzing neurological outcomes and complications. Thes e results have been compared with historical control subjects receivin g laminectomy or ''no treatment.'' METHODS: Between 1982 and 1992, 93 ACC operations were performed for the primary diagnosis of cervical sp ondylotic myelopathy. This consecutive series of patients was reviewed retrospectively. Age, gender, pre- and postoperative myelopathy sever ity, number of levels decompressed, and neurological complications wer e assessed. Myelopathy severity was graded using the Nurick myelopathy grading system. The average follow-up period was 39 months (range, 2- 137 mo). RESULTS: Symptomatic improvement was achieved for 92% of pati ents (F = 28.9, df = 2172, P < 0.001). Nurick scores reflected improve ment for 86% of patients, with the conditions of 13% remaining unchang ed and only one patient showing worsening. preoperative myelopathy sev erity was weakly correlated with age (P < 0.05) but was not correlated with gender or number of levels decompressed. Similarly, postoperativ e myelopathy severity was not significantly correlated with age, gende r, preoperative myelopathy severity, or number of levels decompuessed. ACC-treated patients showed an average improvement of 1.24 points on the Nurick scale, compared with an improvement of 0.07 points for pati ents treated with laminectomy (P < 0.001) and a deterioration of 0.23 points for patients undergoing conservative treatment (P < 0.001). Com plications were slightly move likely to occur in older patients (P < 0 .05). The number of levels decompressed was not significantly correlat ed with complications. Only one permanent neurological complication wa s seen in this series of patients. CONCLUSION: We conclude that ACC is a safe and effective treatment for cervical spondylotic myelopathy. I n an average of 39 months, ACC showed improved results in terms of mye lopathy scores, compared with historical control subjects receiving ei ther no treatment or laminectomy. Age, gender, preoperative myelopathy severity, and extent of disease were not negative predictors of clini cal outcomes.